A pilot study for the primary prevention of rheumatic fever in Kosrae, Federated States of Micronesia.

Rheumatic fever (RF) and its sequel, Rheumatic Heart Disease (RHD) is a disease of significant medical and public health concern in the Federated States of Micronesia. In this preliminary study the feasibility of a rheumatic heart disease primary prevention strategy was examined. Throat swabs were taken from 667 school-aged children and tested for group A streptococci (GAS) by a rapid antigen detection test (RADT): a subset was also tested by conventional culture, so as to compare the RADT with the reference (conventional culture) test. GAS was detected in 124% of the children tested by either rapid antigen test or conventional culture; for RADT alone the detection rate was 11.5% and for culture alone the detection rate was 9.4%. Detection rate of GAS was analyzed in symptomatic and asymptomatic subgroups. The subgroups were compared using Fisher's exact method. The identification of children with GAS allows for their further examination and treatment so that the prevalence of GAS in this vulnerable population, currently with an annual incidence of rheumatic fever of 50-134/100,000, may be reduced. The routine testing of school-aged children appears to be possible with current resources in Kosrae and can be a cost-effective public health measure.